Birth Certificate

      Canton City Health Department
                            James M. Adams, R.S., M.P.H., Health Commissioner

                          Promoting and Protecting Health Since 1849

420 Market Ave. North
Canton, Ohio 44702
(330) 489-3231
(330) 489-3335 (fax)
Info@cantonhealth.org

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Birth Certificate Request Form

Complete this form, print it, then send it via regular mail with a SELF ADDRESSED STAMPED ENVELOPE and the appropriate fee.

The cost for each certified copy of birth records is $18.00.

Use this address to send your request: Canton City Health Department, Vital Statistics Division, 420 Market Ave. N., Canton, OH 44702.

All of the following information is necessary to process your request. If you fail to provide any of the information, your request may be delayed or we may not be able to fulfill your request.

Your Date of Birth:                            Last Name at Birth:


First Name:                                        Middle Initial:


Your Father's Full Name

Your Mother's Maiden Name:

Hospital of Birth:

Mail certified birth record to:
Name:

Address: